Chronic exposure to benzene, the prototypical aromatic hydrocarbon, is associated with an increased incidence of hematologic disorders including aplastic anemia, acute myelogenous leukemia, and multiple myeloma.19 This association has received much attention because of the extensive use of benzene in the workplace. The etiology of these blood dyscrasias is probably not benzene itself but rather a toxic metabolite. Although aplastic anemia is associated with glue sniffing, this is most likely due to the benzene fraction of the glue and not the toluene. Hydrocarbon-induced hemolysis has occurred following the acute ingestion of gasoline, kerosene, and tetrachloroethylene, and inhalation of mineral spirits.20 Consumptive coagulopathy has also been reported.
A peculiar complication of methylene chloride exposure is the endogenous production of carbon monoxide. 21 This is unlike ordinary carbon monoxide exposure from exogenous sources where maximum carboxyhemoglobin level occurs at the time of the exposure. With methylene chloride exposure, carbon monoxide formation may continue after cessation of exposure due to slow release of methylene chloride from the tissues prior to its metabolism to carbon monoxide. When patients exposed to methylene chloride present with CNS and cardiac symptoms, impairment due to significant carbon monoxide production must be considered.
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